Hyperkalemic periodic Paralysis and Prompt Recovery in an elderly Patient with Comorbidities - An Addis Ababa Experience

Hyperkalemic periodic paralysis (HPP) is a rare neuromuscular disorder characterized by episodic muscle weakness associated with elevated serum potassium. We report an 80-year-old male from Addis Ababa presenting with acute lower limb paralysis and severe hyperkalemia (9.08 mmol/L). His medical history included a myeloproliferative disorder under evaluation and severe pulmonary hypertension treated with diuretics. Electrocardiography revealed hyperkalemia-induced cardiac toxicity with widened QRS complexes and peaked T waves. Prompt treatment with intravenous calcium gluconate, insulin-dextrose, and fluid resuscitation successfully lowered potassium levels, reversed paralysis, and normalized cardiac conduction. Acute kidney injury, likely multifactorial from diuretic use and underlying hematologic disease, contributed to the electrolyte imbalance; renal function improved within five days. This case highlights the importance of recognizing HPP in elderly patients with complex comorbidities and demonstrates that timely, guideline-based management of hyperkalemia can prevent life-threatening complications, even in resource-limited settings.